Parker Sr, Paul NEW YORK STATE DEPARTMENT OF HEALTH , N
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Paul M. Parker Sr. Male
Date of Death Age If Veteran of U.S. Armed Forces, . ��`r
U January 12, 2014 77 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Greenwich Street Address 56 Salem Street
Manner of Death Natural Cause X❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined ri❑ Pending
Circumstances Investigation
MI Medical Certifier Name Title
Tracy A. Hebert-Snell,
Address
83 Meeting House Road Schaghticoke, NY 12154
Death Certificate Filed District Number 5 7 22 Register Number
'-- City, Town or Village Greenwich I
❑Burial Date Cemetery or Crematory
January 15, 2014 Pine View Crematory
❑Entombment Address
®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
❑ Removal and/or Held
and/or Address
Hold
Date Point of
❑Transportation Shipment
00 by Common Destination
C1 Carrier
Fa; ❑ Disinterment Date Cemetery Address
'❑ Reinterment Date Cemetery Address
< Permit Issued to Registration Number
Name of Funeral Home M. B. Kilmer Funeral Home 01077
Address
123 Main St., Argyle NY 12809
:. Name of Funeral Firm Making Disposition or to Whom
I' Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued I) I C f y Registrar of Vital Statistics ! 02.,L.--
(signature)
District Number 57 2 2 Place - -Q-Qi 7 12& 3L/
{? I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
• c Date of Disposition 01/15/2014 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
;T
(section) (lot number (grave number)
ow Name of Sexton or Perso in Charge f Premises (toll 1- ,.t NKit
please print)
.: Signature fist— Title eiZenhcoVC
(over)
DOH-1555 (02/2004)